Abstract
Arteriovenous malformations (AVMs) are a high-flow form of a vascular malformation, which can be found anywhere in the body. While historically treated surgically, a multidisciplinary approach utilizing multiple specialties and treatment modalities is now commonly employed. In order to effectively treat an AVM, the nidus must be targeted and eradicated, which can be done via multiple approaches. We present the case of a 43-year-old male with a gastric wall AVM, which was initially incompletely treated using a percutaneous transarterial approach. The gastric AVM was noted to have dominant drainage through a gastrorenal shunt; therefore, Balloon-occluded Retrograde Transvenous Obliteration (BRTO) was utilized to eradicate the AVM nidus. This case illustrates the utility of Interventional Radiology, specifically BRTO, as another treatment option for challenging AVMs.
Similar content being viewed by others
References
Legiehn GM, Heran MK. Classification, diagnosis, and interventional radiologic management of vascular malformations. Orthop Clin N Am. 2006;37:435–74.
Yakes WF, Rossi P, Odink H. How I do it: arteriovenous malformation management. Cardiovasc Interv Radiol. 1996;19:65–71.
Do YS, Park KB, Cho SK. How do we treat arteriovenous malformations (tips and tricks)? Tech Vasc Interv Rad. 2007;10:291–8.
Buckmiller LM. Update on hemangiomas and vascular malformations. Curr Opin Otolaryngol Head Neck Surg. 2004;12:476–87.
Meyer CT, Troncale FJ, Galloway S, et al. Arteriovenous malformations of the bowel: an analysis of 22 cases and a review of the literature. Medicine. 1981;60:36–48.
Khan MI, Baqai MT, Baqai MF, et al. Exsanguinating upper GI bleeds due to unusual arteriovenous malformation (AVM) of stomach and spleen: a case report. World J Emerg Surg. 2009;4:15.
Pastershank SP, Chappell EW, Buchan DJ, et al. Arteriovenous malformation of the stomach. CMA J. 1974;110:57–8.
Kono K, Sekikawa T, Iino H, et al. A case of arteriovenous malformation in the submucosal layer of the stomach. J Gastroenterol. 1994;29:340–3.
Houdart E, Gobin YP, Casasco A, et al. A proposed angiographic classification of intracranial arteriovenous fistulae and malformations. Neuroradiology. 1993;35:381–5.
Vaccaro P, Zollinger RW, Sharma H, et al. Massive upper gastrointestinal hemorrhage from an arteriovenous malformation of the stomach. J Clin Gastroenterol. 1985;7:285–8.
Lee BB. New approaches to the treatment of congenital vascular malformations (CVMs)—a single centre experience. Eur J Vasc Endovasc Surg. 2005;30:184–97.
Lee BB, Do YS, Yakes W, et al. Management of arteriovenous malformations: a multidisciplinary approach. J Vasc Surg. 2004;39:590–600.
Do YS, Yakes WF, Shin SW, et al. Ethanol embolization of arteriovenous malformations: interim results. Radiology. 2005;235:674–82.
Jackson JE, Mansfield AO, Allison DJ. Treatment of high-flow vascular malformations by venous embolization aided by flow occlusion techniques. Cardiovasc Interv Radiol. 1996;19:323–8.
Gloviczki P, Duncan A, Kalra M, et al. Vascular malformations: an update. Perspect Vasc Surg Endovasc Ther. 2009;21(2):133–48.
Ng SC, Thomas-Gibson S, Harbin LJ, Gupta A, et al. Gastric arteriovenous malformation: a rare cause of upper GI bleed. Gastrointest Endosc. 2009;69(1):155–6.
Mccrar JB, Tang SJ, Wu R, et al. Endoscopic and angiographic diagnosis and management of a gastric arteriovenous malformation. Video J Encycl GI Endosc. 2014;2(1):15.
Elazary R. Gastric arteriovenous malformation emerging from splenic artery. World J Gastroenterol WJG. 2008;14(25):4091–2.
Kishino M, Miyasaka N, Takeguchi Y, et al. Retrograde Transvenous Obliteration for Uterine Arteriovenous Malformation. Obstet Gynecol. 2014;123:427–30.
Olson E, Yune HY, Klatte EC. Transrenal-vein reflux ethanol sclerosis of gastroesophageal varices. AJR Am J Roentgenol. 1984;143(3):627–8.
Saad WEA, Sabri SS. Balloon-occluded retrograde transvenous obliteration (BRTO): technical results and outcomes. Semin Interv Radiol. 2011;28:333–8.
Saad W. Balloon-Occluded Retrograde Transvenous Obliteration of Gastric Varices: concept, Basic Techniques, and Outcomes. Semin Interv Radiol. 2012;29(2):118–28.
Saad WE, Wagner CC, Lippert A, et al. Protective value of TIPS against the development of hydrothorax/ascites and upper gastrointestinal bleeding after balloon-occluded retrograde transvenous obliteration (BRTO). Am J Gastroenterol. 2013;108(10):1612–9.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors are military service members. This work was prepared as part of their official duties. Title 17 U.S.C. 105 provides that “Copyright protection under this title is not available for any work of the United States Government”. Title 17 U.S.C. 101 defines a United States Government work as a work prepared by a military service member or employee of the United States Government as part of that person’s official duties.
Ethical Approval
For this type of study formal consent is not required.
Additional information
The views expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government.
Rights and permissions
About this article
Cite this article
Hansing, C.E., Marquardt, J.P., Sutton, D.M. et al. Balloon-Occluded Retrograde Transvenous Obliteration of a Gastric Vascular Malformation: An Innovative Approach to Treatment of a Rare Condition. Cardiovasc Intervent Radiol 40, 310–314 (2017). https://doi.org/10.1007/s00270-016-1470-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00270-016-1470-7